Managing Illness (Child Care Manual)

Infection prevention and control is a simple process that should be a continuous and on-going part of your program.

Managing Illness takes Teamwork

Keep children healthy by ensuring timely communication and cooperation among staff, parent(s) / caregiver(s), health care providers and Public Health.

Every licensee shall ensure that a daily observation is made of each child receiving child care in each child care centre it operates and in each premises where it oversees the provision of home child care before the child begins to associate with other children in order to detect possible symptoms of ill health.
- Child Care and Early Years Act, 2014, S.O. 2014, c. 11, Sched. 1 Section 36. (1)


  • Observe the children as you greet them each morning and throughout the day
  • Communicate with the parent(s) / caregiver(s) as the child may have experienced symptoms the previous evening or overnight
  • Protect the other children in the child care centre from illness
  • Know how and when to contact Public Health
  • Report infectious diseases to Public Health
  • Know how to contact parent(s) / caregiver(s) in the event of illness
  • Establish written policies and procedures in advance to manage outbreaks of infectious diseases, exclusion(s) from the child care centre and infection prevention and control

Parent(s) / Caregiver(s)

  • Inform staff about their child's illness or symptoms
  • Inform staff if their child has been in contact with someone who has an infectious disease
  • Seek medical attention for their child
  • Participate in policy development and revisions
  • Follow the centres policies and procedures

Public Health

  • Assist in preventing illness in child care providers and children in the centre
  • Manage outbreaks of infectious disease
  • Assist with developing written policies and procedures to help prevent and manage illness
  • Act as a resource for health information
  • Manage cases and contacts of infectious diseases

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Public Health as a Support

Call Public Health. We can come to your child care centre and provide your staff guidance and in-services on:

We can also offer your child care attendees an interactive experience on:

  • Clean your hands
  • Cough and sneeze etiquette
  • Story time – germs are not for sharing

To learn more, call 905-688-8248 or 1-888-505-6074 ext. 7330, or email Infectious Diseases.

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Daily Observation of Children

One exposure to germs by a child or adult can be enough to spread infection throughout your centre. Although you can't prevent all illnesses, by knowing what to do, you can control how many people are infected.

  • Be sensitive to how a child feels or looks at drop-off time and throughout the day
  • Share this information with parent(s) / caregiver(s)
  • Respond promptly and appropriately to a new symptom
  • Recognize when a child needs an early pick-up or should stay at home

It's also important to know when to:

  • Alert the parent(s) / caregiver(s) of other children in your program to the presence of infection
  • Protect confidentiality
  • Consult with or notify Public Health.

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Signs and Symptoms of Illness

At drop-off and throughout the day, watch for these symptoms:

  • Unusual behaviour, such as lack of energy, lack of interest or loss of appetite
  • Runny or stuffy nose, cough, or breathing trouble
  • Vomiting
  • Diarrhea
  • Change in skin colour
  • Skin - spots, rash, infected area, itchy skin and scalp
  • Fever / chills
  • Eyes - tears, discharge, swelling
  • Sore throat (painful swallowing or difficulty swallowing)
  • Headache

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Preventing and Managing Illness in Child Care Centres

Clean your hands: The most important thing you can do is to clean your hands well and often throughout the day.

Observe the children daily: Staff should assess a child for illness every day upon arrival to the centre and throughout the day. Communicate to parent(s) / caregiver(s) the importance of keeping staff informed about any illness that the child may have or been in contact with.

Get immunized: Immunization is the most effective way of preventing vaccine preventable diseases such as influenza, COVID-19, whooping cough, measles and mumps. Keep up-to-date health records for children and staff.

Follow proper diaper changing and toileting routines: This is critical as intestinal infections in child care centres are closely related to the presence of young children in diapers.

Put policies in place: Make sure you have written policies that are regularly reviewed and communicated to staff, volunteers and parent(s) / caregiver(s). These should focus on health records, immunization, exclusion criteria, hygiene, cleaning and disinfecting, food safety and contacting Public Health.

Use routine practices: Any person can be carrying an infection and their bodily fluids could contain illness-causing germs. Being aware is especially important when you are in contact with or exposed to bodily fluids. Wash your hands well, use gloves, and clean / disinfect surfaces carefully.

Clean and disinfect surfaces regularly: This is very important as many germs that are spread from person-to-person are stable and live on surfaces for hours and days. Follow these practices consistently to protect children and staff from becoming ill.

Handle and store food safely – This prevents the growth of germs and contamination by insects or rodents

Consider if animals should be permitted: Keep in mind that children and staff may be allergic. An ill animal can be infectious to humans, and even docile pets can bite.

Cover your cough and sneeze: Use a tissue or the sleeve of your upper arm. Don't use your hands.

Prevent sharps injuries.

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Managing Biting Incidents

Young children often bite each other during play or while fighting. Parent(s) / caregiver(s) may be concerned about the possible spread of infections, such as hepatitis and HIV. Although the risk of infection is low, parental anxiety may be high.

  • Make sure your centre has written policies to manage exposures to blood and body fluids by children and staff, including bite wounds. Children cannot be excluded from child care because of hepatitis B, hepatitis C or HIV infection.
  • Staff should be adequately trained and regularly updated on the proper care of bite wounds
  • Ensure first aid supplies are available for the care of wounds, including gloves and bandages. These should be on site and easily accessible.

When a bite occurs

If the skin isn't broken, clean the wound with soap and water, apply a cold compress and soothe the child who was bitten.

If the skin is broken:

  • Allow the wound to bleed gently, without squeezing
  • Clean the wound carefully with soap and water
  • Complete appropriate documentation as per child care centre policy
  • Notify the parent(s) / caregiver(s) of both the biter and the bitten child as soon as possible, preferably within two hours of the incident
  • Advise the parent(s) / caregiver(s) to visit a health care provider to assess the bite and determine the risk of infection and possible need for medication
  • Observe the wound over the next few days and if redness or swelling develops, advise the child’s parent(s) / caregiver(s) to consult a health care provider

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Childhood Illnesses

Diseases of Public Health significance

Bacterial meningitis
All cases must be discussed with Public Health on an individual basis

A child with mild chickenpox can continue to attend child care regardless of the state of their rash, provided they are well enough to take part comfortably in all program activities, including going outside. A child with a high fever or enough spots to be uncomfortable, or who is feeling unwell, should be kept at home until well enough to participate.

Children who have COVID-19 symptoms (regardless if they tested positive for COVID-19 or not) should self-isolate and not attend child care until they are fever free (without the use of fever reducing medication) and other symptoms are improving for 24 hours (or 48 hours if gastrointestinal symptoms are present, like nausea, diarrhea or vomiting).

Hepatitis A
Children with acute infection should be excluded for one week after onset of illness or jaundice (yellowing of the eyes and skin). Public Health staff will be in contact with your child care centre regarding recommendations for contacts of a case.

Influenza (flu)
Children should not attend child care or school until five days after the start of symptoms, or until fever free and can participate in activities.

Exclude for four days after the onset of rash. Public Health staff will be in contact with the child care centre to discuss exclusion of ill child to and recommendations for contacts of a case.

Exclude for five days from the onset of swelling. Public Health staff will be in contact with the child care centre to discuss exclusion of ill child and children who are unimmunized or inadequately immunized.

Pertussis (whooping cough)
A child can return to the child care centre three weeks after intense coughing begins, or after five days of appropriate antibiotic treatment.

Rubella (German measles)
Exclude for seven days after the rash is first noticed. Public Health staff will be in contact with your school or child care centre to discuss exclusion of ill child and children who are unimmunized or inadequately immunized.

Report Diseases

Report diseases to the Infectious Disease program at 1-888-505-6074 or 905-688-8248 ext. 7330, Monday to Friday 8:30 a.m. to 4:30 p.m. For reporting after hours, call 905-984-3690.  

Non-reportable Illnesses

Common cold
Children may continue to attend the child care centre if feeling well enough to take part in regular daily activities.

A child can attend the child care centre 24 hours after they no longer have symptoms of diarrhea or 48 hours if the centre is in an outbreak situation. This may vary depending on cause of illness, number of cases and source of infection.

A child must be fever-free, without the use of fever-reducing medicine, for 24 hours before returning to the child care centre. Upon return, the child must be able to participate in all activities including outdoor play.

 Fifth disease
A child can attend the child care centre because they are no longer contagious once the rash appears.

 Hand / foot and mouth
A child may return to the child care centre when feeling well enough to take part in activities. However, keeping young children at home who drool and have blisters in the mouth or children with a weeping rash on the hands, can help to reduce the spread of infection to others.

A child should not return to child care until the antibiotic prescribed by a health care provider has been taken for at least one full day (24 hours), and the child is well enough to take part in all program activities.

Molluscum Contagiosum
No exclusion necessary.

 Pink eye
A child with pink eye should be kept home until seen by a health care provider. If bacterial, the child can return to the child care centre after 24 hours of appropriate antibiotic treatment. If viral, the child can return with the health care provider’s approval. No need to exclude if there's no eye discharge, unless there is an outbreak

Children can return to child care after treatment has started.

Children can return to child care after treatment has started.

Children may continue to attend child care centre if feeling well enough to take part in regular daily activities.

Children can return to child care after treatment has been applied.

Strep throat
A child should not return to child care until the antibiotic prescribed by a health care provider has been taken for at least one full day (24 hours), and the child is well enough to take part in all program activities.

Steps to identify infection

  1. Observe children at drop-off every day before they interact with other children at your centre
  2. Be prepared to deal with illness when it occurs. If a child appears ill, separate this child from other children.
  3. Notify the parent(s) / caregiver(s) promptly and request that the ill child be picked up
    • Ask that the child be kept at home until recovery is complete and the child is no longer infectious
    • Immediately report any diseases of Public Health significance to Public Health
    • Be especially attentive to children in the child care centre who have cancer
    • Document the illness as required by your centre
    • Continue to observe other children for similar symptoms

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Report Diseases to Public Health

The Medical Officer of Health, under legislated authority and with the Board of Health, is responsible for the health of the public. The medical officer provides expertise, leadership and guidance in all public health matters.

According to provincial legislation, certain diseases must be reported immediately to Public Health.

Post the diseases of Public Health significance resource in a visible location and make staff aware of its content.

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Last updated: Sept. 28, 2022

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